The Surprising Source of Improving Female Health and Well-Being in Developing Countries


The following is an excerpt from the new book Power Play: How Video Games Can Save the World by Asi Burak and Laura Parker (St. Martin's Press, 2017): 

In the summer of 2012, Games for Change co-president Michelle Byrd traveled to Nairobi, Kenya, with a bag full of mobile phones. Each phone was preloaded with a game called 9 Minutes. The game, co-developed by Games for Change, was created to teach pregnant women in developing countries about nutrition and best practices during pregnancy, like how much sleep to get and when it’s necessary to visit a doctor. It plays like an arcade game, in which the player must identify and collect “positive” icons related to diet, health, and behavior, and ignore “negative” ones. (For example, tomatoes and fruit count as positive, while coffee and wine are negative.) There are nine levels in total, no longer than a minute each, to represent the nine months of pregnancy. At the end of each level, a text pop-up informs players what they got right and wrong and makes suggestions regarding checkups, HIV testing, and other health-related matters.

In Kenya, Byrd visited schools, community centers, youth leadership organizations, and medical clinics, showing the game to as many people as possible—both women and men. More than 65 percent of Kenya’s 40 million people own mobile phones; in Kibera, Africa’s largest slum, home to some one million people, more than 75 percent of inhabitants have access to mobile devices. Maternal mortality is especially prevalent in Kibera, where one in 26 women dies in childbirth. At one of the slum’s busy clinics, Byrd met with the director and a handful of her patients, all young women who watched patiently as Byrd explained how the game worked.

“A lot of women in Nairobi don’t believe there’s any real need to start pregnancy visits until they’re showing,” the director of the clinic told Byrd. “Some think it’s okay to just deliver at home.”

Byrd showed one young woman the game. “So, should you eat a tomato while you’re pregnant?” Byrd asked the woman. The woman hesitated, and then nodded slowly. “There’s reticence for these women to talk openly about their bodies,” Byrd said recently. “The game was like an icebreaker—a small win dow into what each woman was doing day-to-day, what she was eating, how much sleep she was getting, and so on.”

A reporter from Kenyan TV showed up to film a segment about the women playing 9 Minutes. After interviewing some of those who had played the game, she turned to the camera and noted that while 9 Minutes seemed to offer plenty of health tips, many of the women who turned up to the clinic would be glad just to have something to do while waiting in line.

The game 9 Minutes was one of four games—one Facebook game and three mobile games—developed in partnership with the Half the Sky Movement, spearheaded by journalist and author Sheryl WuDunn and her husband, New York Times columnist Nicholas Kristof.

The story begins with the publication of Kristof and WuDunn’s book Half the Sky: Turning Oppression into Opportunity for Women Worldwide, in 2009. In the book, Kristof and WuDunn describe the oppression of women around the world as the “paramount moral challenge” of our time. WuDunn has written and lectured extensively on the economic, political, and social status of women in the developing world and in the United States. Kristof is a celebrated reporter whose column often focuses on international humanitarian issues. Together, the couple covered the 1989 Tiananmen Square massacre in China for the Times; a year later, they won the Pulitzer Prize for journalism—the first married couple to do so. (Kristof won a second Pulitzer in 2006 for his coverage of the genocide in Darfur.)

But in Half the Sky, Kristof and WuDunn do more than report. Chapter by chapter, they recount their personal experiences traveling through Asia and Africa, meeting girls and women struggling against a system that is determined to favor their oppressors: women who are beaten, raped, and sold into slavery; who are stoned or burned to death if they are considered to have brought shame upon their families; or whose faces and bodies are disfigured by acid.

The stories are tragic but not without hope. Many of the women Kristof and WuDunn profile are survivors. A Cambodian teenager, Srey Rath, who was sold into sex slavery, escaped from her brothel and went on to become a successful businesswoman. Mamitu, an Ethiopian woman who suffered an obstetric fistula as a result of a prolonged, obstructed labor in her first pregnancy, hung around the surgeon who helped treat her and eventually learned to do fistula operations herself. A Pakistani girl, Mukhtar Mai, who was gang-raped, fought for her rights. Eventually, Pervez Musharraf, who was Pakistan’s president at the time, directed that the government award her compensation. She used the money to open a school in her village.

Look at these women, WuDunn and Kristof say—look how they turned their narrative around to thrive and become leaders in their communities.

Now, imagine what else they could have done if they’d only had a little help. In their introduction, the authors describe the event that motivated them to write the book. Tiananmen Square was the human rights story of 1989, but in 1990, Kristof and WuDunn stumbled upon another human rights violation, one few people knew about: according to an obscure demographic study, 39,000 baby girls died annually in China because their parents didn’t provide them with the same medical attention that boys in the family received. A Chinese family-planning official described the situation to Kristof and WuDunn this way: “If a boy gets sick, the parents may send him to the hospital at once. But if a girl gets sick, the parents may say to themselves, ‘Well, let’s see how she is tomorrow.’ ”

Where were the news reports about this? “Those Chinese girls never received a column inch of news coverage, and we began to wonder if our journalistic priorities were skewed,” Kristof and WuDunn wrote. They began to see similar patterns in South Asia and the Middle East. In India, they discovered that bride burning, or dowry killings, occur roughly once every two hours, a horrific practice that is common when a husband’s family believes they have not received enough money as part of the wedding dowry and the bride’s family is unable to pay more. In Pakistan, they found that some 5,000 women and girls had been doused in kerosene and set alight by family members in the preceding nine years. According to the United States Agency for International Development (USAID), which is responsible for foreign aid, 62 million girls around the world are not in school, and an estimated 100 million will drop out before completing primary school. Globally, one in seven girls marries before turning 15, and one in three women experience gender-based violence.

“When a prominent dissident was arrested in China, we would write a front-page article; when 100,000 girls were routinely kidnapped and trafficked into brothels, we didn’t even consider it news,” Kristof and WuDunn wrote. “Partly that is because we journalists tend to be good at covering events that happen on a particular day, but we slip at covering events that happen every day—such as the quotidian cruelties inflicted on women and girls. We journalists weren’t the only ones who dropped the ball on this subject: less than one percent of US foreign aid is specifically targeted to women and girls.” (This figure has improved significantly since then: the majority of foreign aid now goes to health programs, particularly HIV/AIDS and maternal and child health initiatives.)

Critics loved the book, praising its scope and message. It hit #1 on the New York Times bestsellers list for nonfiction books, and found a sizable international readership. Celebrities liked it too. “These stories show us the power and resilience of women who would have every reason to give up, but never do,” Angelina Jolie wrote of Half the Sky. Here’s George Clooney: “I think it’s impossible to stand by and do nothing after reading Half the Sky.” Then Oprah Winfrey took up the cause, and the Half the Sky Movement, as it came to be known, was born.

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